Yuanjie Zou

Objective: This study aimed to analyze the anatomic variations of the trigeminal arachnoid membrane (TM) and evaluate its implications for microvascular decompression (MVD) surgery in patients with trigeminal neuralgia (TN). Understanding the structural variations of TM is essential for improving surgical outcomes. Methods: A retrospective analysis was conducted on 377 TN patients who underwent MVD between January 2017 and December 2023. Intraoperative video recordings were reviewed to classify the TM into 4 subtypes based on consistency, opacity, and thickness. Patients were followed for at least 10 months, with surgical techniques, including trigeminal nerve isolation, utilized to manage neurovascular conflicts and arachnoid adhesions. Results: The TM was classified into 4 subtypes: absent (10.3%), filamentous (41.1%), membranous (43.5%), and thickened (5.1%). Neurovascular conflicts were present in 97.3% of cases, with the superior cerebellar artery being the most common offending vessel. TM subtypes influenced the complexity of the surgery, with thicker and more opaque TMs presenting challenges in visualization and nerve decompression. Conclusions: The anatomic variations of TM play a critical role in MVD for TN. Understanding these subtypes enables more precise surgical planning, potentially reducing complications and recurrence. Standardized protocols for managing arachnoid membranes could improve outcomes and reduce the recurrence of TN symptoms. Future research should focus on developing advanced surgical tools and techniques to address the challenges posed by TM, particularly the thickened subtype.

Objective: This study aims to investigate the impact of the offending vessel’s compression location on intraoperative lateral spread response (LSR) waveform parameters during microvascular decompression (MVD) for hemifacial spasm (HFS). Additionally, the study evaluates the clinical significance of LSR variations in intraoperative electrophysiological monitoring.Methods: A retrospective analysis was conducted on 72 patients with HFS who underwent MVD at Nanjing Brain Hospital between September 2021 and September 2023. Patients were categorized into two groups based on the compression site of the offending vessel on the facial nerve: the transitional zone (TZ) group and the attached segment (AS) group. General clinical characteristics, intraoperative LSR parameters, and postoperative outcomes were compared between groups. Statistical analyses focused on LSR latency, amplitude, and duration, as well as the patterns of LSR disappearance and postoperative complications.Results: The TZ group comprised 31 patients, while the AS group included 41. No significant differences were observed in baseline characteristics between groups. Intraoperative monitoring revealed that LSR disappearance was more frequently incomplete in the TZ group (11.1%) than in the AS group (p < 0.05). LSR latency was significantly longer in the AS group (p < 0.001), while the amplitude in the orbicularis oculi muscle was lower in the TZ group (p < 0.001). Additionally, LSR duration (T2) in the orbicularis oris (p < 0.05) and mentalis muscles (p < 0.01) was longer in the AS group, though the amplitude differences were not statistically significant. Postoperative outcomes showed no significant difference in effectiveness between the groups (AS: 92.7% vs. TZ: 93.5%, p = 0.882). Complications, such as facial palsy and hoarseness, were slightly more common in the AS group, whereas hearing loss and ataxia were more frequent in the TZ group. However, none of these differences reached statistical significance.Conclusion: The compression location of the offending vessel significantly influences LSR parameters, with longer latency and prolonged duration observed in the AS group. Despite these variations, postoperative outcomes and complications were comparable between groups. These findings highlight the importance of considering the compression location during MVD and the potential value of LSR monitoring in guiding surgical decision-making.

We present the case of an adolescent female patient diagnosed with a ruptured lateral ventricle teratoma. Distinctive radiological and microscopic findings revealed floating oily globules within the ventricles and subarachnoid space. The spontaneous rupture of the teratoma may be attributed to age-dependent hormonal changes, which increase glandular secretion, cyst content volume, and intra-cystic pressure. The patient underwent gross total resection of the tumor, and the subsequent pathological examination confirmed the diagnosis of mature teratoma. Postoperatively, she was managed with routine follow-up without adjuvant chemotherapy or radiotherapy. During the 1-year follow-up period, the patient remained asymptomatic with no evidence of tumor recurrence. Based on this case, we recommend that gross total resection followed by close monitoring, without adjunctive chemotherapy or radiotherapy, can be an effective treatment strategy for patients with similar presentations.

The rhomboid lip (RL) is a layer of neural tissue that extends outside the fourth ventricle and is connected to the lateral recess of the fourth ventricle. Although this anatomical structure has been rigorously studied, it is often overlooked in microvascular decompression (MVD) surgery. In this report, we present two cases, one of hemifacial spasm (HFS) and one of glossopharyngeal neuralgia (GPN), in which a large RL was observed during surgery. We found that a large RL is easily confused with arachnoid cysts, and accurate identification and dissection are important to protect the lower cranial nerves.

Background: Rosai-Dorfman-Destombes disease (RDD) was first described in 1965 as a benign histiocytic proliferative disorder of unknown cause. Cases of RDD limited to cutaneous tissue have been reported over the past few decades, but single cutaneous RDD of the scalp is rare.Case presentation: We report a 31-year-old male with a lump on the parietal scalp without extranodal lesion lasting 1 month with gradual enlargement. The surgical incision ruptured with purulent after the first resection. Then the patient was treated with plastic surgery after disinfection and antibiotic treatment. Finally, he recovered well and discharged after 20 days.Conclusions: RDD of the scalp is rare. Surgical incision can cure the lesion but it may become infected because of increased lymphocytic infiltration. Early diagnosis and differential diagnosis of RDD are necessary. For treatment, individualized therapy is critical to patient prognosis.

This study aimed to compare the outcomes of trigeminal nerve isolation (TNI) with conventional microvascular decompression (CMVD) in cases of trigeminal neuralgia (TN). We retrospectively reviewed 143 TN cases who underwent microvascular decompression from January 2017 to January 2020. The surgical management of TNI or CMVD in all patients was randomized. The cases were divided into two groups, one group underwent a TNI and the other one received CMVD. The general data, postoperative outcomes, and complications were reviewed retrospectively. Cases with a narrow cistern of cerebellopontine, short trigeminal nerve root, and arachnoid adhesion were defined as difficult cases. All of the cases were followed up for at least 1 year. Surgical outcomes were assessed and compared between the two groups. In results, we found no significant differences in the general data, duration of hospitalization and blood loss between the two procedures. However, of the 143 cases, 12 cases (17.1%) recurred after surgery in the CMVD group, and four cases (5.5%) recurred after TNI operation. The rates of pain relief were 69 (94.5%) in the CMVD group, and 58 (82.9%) for TNI (P=0.027). In the TNI group, there was only one difficult case among four no pain-relief cases, while in the CMVD group, 10 difficult cases were found among the 12 no pain-relief cases (P=0.008). In conclusion, the TNI technique is more effective than the CMVD procedure and could also be performed on patients with classical TN. Future double-blind and randomized controlled trials are necessary to confirm this result.

BackgroundInterferons (IFNs) have been implemented as anti-tumor immunity agents in clinical trials of glioma, but only a subset of glioblastoma (GBM) patients profits from it. The predictive role of IFNs stimulated genes in GBM needs further exploration to investigate the clinical role of IFNs. MethodsThis study screened 526 GBM patients from three independent cohorts. The transcriptome data with matching clinical information were analyzed using R. Immunohistochemical staining data from the Human Protein Atlas and DNA methylation data from MethSurv were used for validation in protein and methylation level respectively. ResultsWe checked the survival effect of all 491 IFNs response genes, and found 54 genes characterized with significant hazard ratio in overall survival (OS). By protein-protein interaction analysis, 10 hub genes were selected out for subsequent study. And based on the expression of these 10 genes, GBM patients could be divided into two subgroups with significant difference in OS. Furthermore, the least absolute shrinkage and selection operator cox regression model was utilized to construct a multigene risk signature, including STAT3, STAT2 and SOCS3, which could serve as an independent prognostic predictor for GBM. The risk model was validated in two independent GBM cohorts. The GBM patients with high risk scores mainly concentrated in the GBM Mesenchymal subtype. The higher risk group was enriched in hypoxia, angiogenesis, EMT, glycolysis and immune pathways, and had increased Macrophage M2 infiltration and high expression of immune checkpoint CD274 (namely PD-L1). ConclusionsOur findings revealed the three-gene risk model could be an independent prognostic predictor for GBM, and they were crucial participants in immunosuppressive microenvironment of GBM.